Why Hospice Organizations ...
DON'T Want You to Know the Truth!

With the publication of the 8/20/01 USA TODAY articles about
hospice, several hospice industry lobbying groups have gone
"ballistic" denouncing the article as a twisted,
unbalanced version of what is happening in hospice today. The
reality is that hundreds of articles promote a "Mary
Poppins" view of hospice so that the public has no idea of
the problems that can arise in hospice, until it is too late. The
USA Today article provides the balance that is needed by
presenting the other side of the story, so the public is
forewarned that sometimes, things can go wrong in hospice. We see
that situation very clearly from the letter to the Editor sent in
from New York State.

Hospice states, "We don't do weekends!"

Hospices are required to provide services necessary to meet
the needs of the patient and family related to the terminal
illness. Hospice industry representatives state that the industry
adheres to the highest of standards of care, but L. Rodger
from New York state wrote a letter to the Editor of USA Today
(8/25/01) stating that the hospice her father was enrolled in did
not provide services on the weekends! She explained [by phone to
Hospice Patients Alliance later on] that her father had had good
pain control while in the hospital, before admission to hospice,
but was in severe pain from Wednesday through Sunday. That her
father had good pain control in the hospital seems to indicate
that the pain could be controlled by medication.

Linda reported that the hospice RN visited at the time of
admission on Wednesday, slapped on a pain patch and never came
back to adjust the pain medications to make sure the pain was
controlled. She stated: an aide visited on Thursday and Friday am
for a brief period of time, and nothing at all more! She also
reported that the hospice never informed the patient or family
that the required service: continuous nursing care, could be
provided under the criteria that pain was out of control; that
the hospice never provided continuous care to assure the pain was
controlled (it was not); she reported: when begged for
assistance, the hospice refused to send anyone out at all. She
and the family managed without the hospice and the hospice
finally called on Monday, only to learn that Linda's Dad had
passed away while the hospice was busy "not doing
weekends."

Well, apparently patients all have to die during the week, and
certainly are not allowed to have problems or crisis symptoms on
the weekend, or even during the week in this case. Linda was
appalled that the hospice did not even try to control her
father's pain, which was so severe he could not be touched or
moved once under the hospice's services, and no services were
provided on weekends, even though all hospices are reimbursed for
every day the patient is enrolled in the hospice. Linda
was so disgusted with the hospice's services total lack of
concern and even though she loved her Dad, felt that her
father's death on Sunday allowed him to go on to a better
place and that he did not have to suffer any more excruciating
pain under this hospice's care.

We wonder what services such a hospice provided to justify its
billings to Medicare for every day the patient was
enrolled (including weekends) in hospice ... or did the hospice
only submit bills for the days during the week: Wednesday through
Friday? Those who are familiar with hospice would know that
submitting bills for only weekdays and not the weekends is not
possible, because patients are "enrolled" officially
into hospice only one time normally and the bills are
not sent for this day or that day, but for all the days
from admission into hospice up till the end of hospice services
at "discharge" from hospice due to the patient's
death or transfer to another hospice.

Linda's father's case is not at all unusual. We hear
about similar cases, variations on the theme of hospices
underserving patients, from all over the USA. While there are
excellent hospices and staff out there, the "rogue"
hospice makes it difficult for the patients and families they
enroll. Patients and families have no guarantee in the real
world, that they will automatically find an ethical hospice. It
is a matter of chance which type of hospice you or any other
family will use.

"If you fill out a form incorrectly, and if you do it
intentionally, you can end up in jail. Hospices have been taking
a beating."

Well, any person who fills out a form incorrectly with the
intent to commit health care fraud, is defrauding the government.
Do you fill out forms incorrectly on purpose when dealing with
Medicare? Would you fill forms out intentionally wrong if you
knew it was a felony crime? Just as in any other business, if you
fill out a form incorrectly, knowingly, and it results in felony
fraud taking place (stealing millions of dollars from Medicare
over time), and you knew about it, that is called health care
fraud. Should any person, even in a hospice, be charged with a
felony crime if they knowingly commit felony crimes? Of course
they should! Hospice staff are subject to the laws and even
hospice administrators are subject to the laws. It is
not too much to ask that hospice administrators and
staff also follow the laws of our nation and the states! ...
unfortunately some hospice administrators believe that they do
not have to fill out forms correctly when dealing with our health
care system.

"There is no kind of dishonesty into which otherwise
good people more easily and frequently fall than that of
defrauding the government."
?? - ?? Benjamin Franklin

Hospice Organizations do Not Want You to Know
About Fraud in Hospices

The Hospice Industry is a white-collar criminal's dream
environment, because there is almost no real oversight of what is
going on. And, the public image of hospice as so
"compassionate" ensures that any real effort to
prosecute a rogue hospice will be met with reactions like,
"how could they go after such compassionate
people?" Of course, the public does not hear about all the
violations occurring in the rogue hospice. ... they only
publicize the wonderful services. Remember, even a rogue hospice
will do some good hospice services, otherwise they'd be
immediately detected and shut down.

For example, one well known large hospice had over 200 pages of
violations written up in the State inspector's report, but
the public has no idea about that. The public also doesn't
know that the same types of violations which were cited a few
years earlier were again found at this same hospice: the
violations were never corrected! Even though a hospice
puts in its "plan of correction" after being cited by
the state inspectors, not all hospices fix the problems found.
The rogue hospices just go through the motions of appearing to
comply.

This same hospice is very well known in the state and most
people don't even know that other hospices exist, since this
hospice advertises constantly in radio and TV: they have big
political connections, million dollar donations coming in, and
are working to take over the entire hospice services for the
state and surrounding region. Similar activities are occurring in
rogue hospices all around our nation. How do we know? We receive
a continual stream of complaints from every region of the nation.
And these complaints come not only from "laypersons"
but also from doctors, nurses, attorneys and other very well
educated and objective observers.

The type of hospice that such a "rogue" hospice runs
is virtually the opposite of the type of care provided by the
ethical hospices. That is why some ethical hospice adminstrators
complain about the USA Today articles...these administrators are
simply naive and don't realize what the rogue hospices
intentionally do to violate the standards. It is a characteristic
of the honest, that they cannot believe that others are dishonest
and would actually knowingly scam Medicare, Medicaid and exploit
the patients themselves for financial gain. The honest project
their own honesty on the rogue hospices, not wanting to believe
the reality of what is going on in the industry.

This hospice works to get exclusive referrals from medical
groups and hospitals as well as nursing homes, thereby basically
shutting off the referral sources for the other hospice agencies
in the state (which are competitors). Their goal: ? to have
almost all the terminally ill sent to their hospice agency so
they get the biggest market share and to destroy the other
hospice agencys' foundation, making them irrelevant or
nonexistent. Make no mistake about it: the rogue hospice is
fighting a competitive business war to stifle the competition and
win the financial game. They brag about running their hospice
"as a business" but have intentionally violated
standards to increase revenue/income.

Sure, the state may come in periodically every two or three
years, or eight years (as in some hospices), and they may cite
the agency for a deficiency (even though criminal activity was
occurring), but the state almost never shuts down any hospices
that commit fraud. The federal government (US OIG) almost never
shuts down a hospice [or nursing home or hospital] that commits
fraud. They "settle" with the hospice, often getting
back only a percentage of what was fraudulently taken, thereby
rewarding the white-collar criminals for stealing from the
taxpayers, through Medicare and Medicaid fraud.

Hospice administrators complain, "Hospices have been taking
a beating." Well, that is news. That is really big news,
because it is extremely difficult to find any news about hospices
taking a beating. Where did this beating occur? What hospices are
or were involved? Out of over 3,300 separate businesses/hospices
how many have had any major problem with actual charges being
brought against them for fraud? Not that fraud isn't
happening, but we would like to know about any charges actually
brought against hospices for the fraud they commit, because the
government's efforts to stop fraud in hospice are totally
underfunded and quite ineffective. Staff at the US OIG report
that they have a backlog of thousands of health care fraud
complaints from all over the US involving the entire health care
industry. When the US OIG started up its Operation Restore Trust
(3/95) to investigate fraud specifically in hospices, a few years
back, the hospice industry was up in arms, and successfully got
the federal government to back down.

Federal efforts at uncovering fraud in hospice have been a
huge failure. Investigations into hospices have been suspiciously
shut down without any reason. If hospices are taking a beating
for violating the laws, it is justified, but actually hospices
have not been taking a beating, and are among the least regulated
industries in health care. They are virtually untouched by law,
even though they protest loudly when even slight efforts are made
to rein in the health care fraud occurring in hospice.

Hospice Organizations Don't Want You to Know that
Regulations Mean Nothing to the Rogue Hospice

Hospice spokesmen like to complain that they are overloaded
with regulations, and if they "intentionally fill out a form
wrong," they might have trouble from state or federal
regulators. In the hospice industry's view, no problems arise
out of intentional mismanagement by the hospice agencies. In the
hospice industry's view, no serious problems exist. They
would like the public to remain uninformed and ignorant about the
serious problems confronting end of life care. They will not
admit to the wrongdoing by white collar criminals in the hospice
industry. State or national hospice groups will be the last to
admit any wrongdoing in hospice agencies, because the hospice
agencies pay the dues to the hospice association. Basically, the
hospice associations would not exist without the agency members,
so they will not "bite the hand that feeds them."

The hospice industry has very cleverly cultivated positive media
coverage in TV, radio and the print media. Hospices raise money
together with media of all types. They proclaim how compassionate
end of life care is when a hospice is involved, which is what
hospice is supposed to be. However, when anything goes wrong,
they do not admit responsibility for the hospice agency's
wrongdoing, but either scapegoat what they call a
"misbehaving" nurse, physician or other staff member or
they completely deny that what happened - actually happened!

Hospice Agencies Don't Want to Lose Donations

Hospice industry representatives are very concerned that they
might lose donations to the local hospices if people knew the
truth about abuses by hospices. They have worked very hard to
make the public believe that all hospice agencies are one big
"hospice" ... some amorphous end of life care setting
that provides care to all throughout the US. They often say,
"donate to hospice" rather than "donate to our
individual hospice corporation, which just happens to be paying
our administrators hundreds of thousands of dollars, in the case
of larger hospice corporations." They do not tell the public
that very large hospices often pay up to a hundred thousand
dollars (or more) each year to big city attorneys to advise them
how to skirt the regulations or get out of trouble when
wrongdoing is discovered!

Hospice industry spokesmen do not tell the public that their
hospice is a business, determined to make money in the case of
some large and ambitious for-profits but publicly profess their
dedication to "serve the public" while they enrich
themselves and their stockholders. In the case of some very large
nonprofit hospices, even they can pay their administrators
hundreds of thousands of dollars while denying basic services to
the patients and families.

Do all your donations to hospice go to end of life care? Or do
they go to end of life administrators who enrich themselves at
the expense of the patients and families? Why don't the big
hospices release information about the salaries they pay to their
top administrators? Why don't they tell you about the
administrators who are driving around in Mercedes Benz
convertibles or Porches, while their staff are generally
underpaid and overworked? Why don't they tell you how they
fire experienced hospice nurses so they can hire inexperienced
hospice staff at lower salaries? And then let's see them
explain why inexperienced nurses are sent out on cases that
require expert palliative care! Why don't they tell the
public about how they dump patients who live too long! Do
hospices tell the public about the "behind the scenes"
confrontations between hospice staff who protest violations of
the standards of care, only to be told by mangement that the
policies in place will be continued, even though they violate the
regulations covering hospice.

Hospice Organizations Don't Want You to Know about
Competition for the Dying Among the Hospice Agencies

How many smaller hospice agencies have complained to us here
at Hospice Patients Alliance, that the big hospice corporations
are trying to drive them right out of business! How do they do
it? By making exclusive referral arrangements between their large
hospice and the local hospital and nursing homes. The US Office
of Inspector General has confirmed that even illegal kickback
arrangements are employed to secure such exclusive referrals. See
OIG Kickback
Alert and OIG Fraud
Alert. Make no mistake about it: there is fraud in some
hospices and fierce competition among separate hospices for dying
patients who are seen as "revenue sources." Each
hospice is a separate legal entity, ... separate business seeking
revenue. It is not "one big happy family." How many
hospice spokesmen will tell the public of the dismay some
hospices experience when rogue hospices enter their area! See the
Washington Post archives for the 6/14/98 article
"Hospices Big Business, Thanks to Medicare; Exploitation
of some patients is alleged" written by Charles R.
Babcock, or a review of that
article.

Hospices Don't Want You to Know that
Hospice Staff Who Protest Fraud or Wrongdoing
In Hospice are Harassed, Intimidated or even Fired

Many hospice staff write in to tell us how they were harassed
or intimidated for speaking out about simply meeting the
standards of care. When they question administrative hospice
policies that enrich the hospice, but abandon the needs of the
terminally ill, they find themselves under attack by management.
This type of management tactic is confirmed by research done by
the American Nurses Association, showing that nurses in almost
all niches of health care find that they are unable to properly
perform their duties in many settings, due to short staffing and
other management decisions that interfere with the provision of
optimal patient care.

Story of Cathleen Kyle, RN in the Boston Globe article
(1/21/99):
(search the Globes archives for title shown above).

HMO/Managed care style management has entered into hospice
administrations as well. We have personally witnessed and
experienced harassment and intimidation by hospice administrators
who did not wish to comply with the standards of care. The same
type of management style that has blackened the reputation of
health care agencies nationwide, has firmly entered into hospice
management practice, directly harming not only patients, but also
health care professionals, including doctors, nurses and other
staff who wish to fulfill their licensed duties to the patients
they serve. For more information on problems employees have when
they "blow the whistle" on intentional wrongdoing in
industries, see the National Whistleblower Center.

Submitting false claims to Medicare and Medicaid are much more
common than the public believe. In hospice, false claims occur
when they bill for services they never rendered or even offered
to the terminally ill. Reimbursement is on a per-diem basis, but
if the hospice refuses to send out staff when needed, they just
keep collecting daily reimbursement without providing needed
services. Whistleblowers in many industries are routinely
harassed, intimidated or immediately terminated from their jobs
for revealing the truth (long after staff try to convince
management to stop stealing from the government and private
sources of reimbursement). See The False Claims Act in Whistleblower Litigation
from the law offices of Mark Kleiman, Esq.

Huge Medicare and Medicaid budgets offer white collar
criminals/opportunists a dream environment where they are not
only rarely caught, they are almost never sent to jail, and if
forced to repay funds fraudulently taken from the government,
they are not required to pay all of it back. For example, if they
steal $48 million, the US OIG Compliance Integrity Agreements only require
them to pay back $45 million, thereby rewarding them with a
payment of $3 million to steal from the government. One nursing
home chain got to keep $285 million, while only paying back $175
million out of $460 million of fraudulent billings to Medicare.
(see: list of largest nursing home chains where some of these
corporations are listed as having filed corporate integrity
agreements that allow them to keep millions of dollars of false
claims, according to the US OIG).

The variation between ethical hospices and
Rogue hospices is like night and day!

Those members of the public who have experienced an ethical
hospice cannot imagine the horror of having a rogue hospice fail
to provide care for their dying loved one. Those members of the
public who only know what they experienced at the hands of a
rogue hospice, can't imagine that ethical hospices even
exist. A balanced view needs to exist, so that real reform can be
started to repair the damage done by unethical hospices who
exploit the good name of hospice built by the ethical hospice
agencies and staff.

Hospice representatives know that the relationship between
hospice and patient and family is based on trust, just as it is
in any health care setting. What they don't want to admit is
that some hospice agencies and some staff don't deserve the
trust of the public. White collar crime, health care fraud is
taking place in hospice just as it is in other health care
arenas. Health care fraud investigators have told us, "fraud
in hospice is rampant." It is one of the least
regulated industries in health care. Nursing homes and hospitals
are much more stringently regulated. Many hospices are
never inspected unless there is a complaint from the
public. One hospice in California did not get inspected for
eight years!

When hospice administrators suggest that the public contact
state regulators if there is a problem, they know that state
inspectors are very few and unable to even begin to cover the
territory assigned to inspect. A complaint from the public may be
acted upon by the state six or more months later, long after the
patient has died. And what is the result of such complaints?
Hospice agencies just put in writing a "plan of
correction" and the state moves on, assuming that
corrections will be made, sometimes inspecting again to give the
appearance that they assured that the standards of care were
being followed. Nothing could be further than the truth. It is
common for the same type of complaints to be received about
hospices, long after they supposedly "corrected" the
problem in the first place. State regulation of hospices is a
dismal failure and the hospice agencies and lobbying groups know
that they have no fear from state regulation.

When hospice administrators complain about "too many
regulations" they are only covering up that if there were
fewer regulations, they could get away with even more skimpy
care. How many families call desperately stating that the hospice
nurses don't come out when they needed them! How many have
reported that they were told "the nurse will be out tomorrow
or the day after."

We know, however, from our own experience and that of many
hospice nurses and staff who have contacted us that some
hospice administrators do intentionally violate standards, order
staff to falsify medical records to cover up their wrongdoing,
lie to families and staff about what the standards of care are
and even, in some cases, euthanize patients who have become
"too expensive" to care for, i.e., their need for
services is beyond what the hospice wishes to expend compared
with what the hospice is getting as reimbursement.

And is the government very concerned? Well, state Medicaid and
federal Medicare budgets would be greatly relieved if patients
are eliminated at the costliest time of their disease process:
the last three months of life. While enrolling terminally ill
patients in hospices saves the government budgets millions of
dollars, euthanasia or physician-assisted suicide would save much
more. There are many officially unreported cases of euthanasia
going on in nursing homes and hospices.

In 1992, California's then Attorney General Daniel E.
Lungren commented on a proposal to legalize euthanasia and
stated, "This measure would result in some unknown savings
due to decreased utilization of the state Medi-Cal program and
other public programs, including county programs."
That's about as cold an analysis that could be given,
especially when we're talking about medically killing people
who just happen to be patients as the way to save money (called
"decreased utilization" of health care budget dollars).

Why don't industry representatives tell the public about the
"clever" maneuvers rogue hospices use to avoid scrutiny
by other medical professionals? For example, the regulations
require that the medical director of the hospice act as a
counter-balancing force to make sure the medical needs of the
hospice patient are met. What do rogue hospices do? They mislead
physicians in the community to think they must "sign
off" on the case when their patient enters hospice. In this
way, the hospice medical director has a free hand to do whatever
and no snoopy attending physician will ever know the details of
the care and services provided or not provided.

The hospice regulations [see 42
CFR ch iv, part 418] envision that the patient will have
two physicians monitoring the quality of the care: the
regular attending physician and the hospice physician. Each one
acts as a "check and balance" to the other so the
patient's best interests are met. These hospices manipulate
the patient to give up their regular attending physician and use
the medical director so there is no check and balance. Are the
hospice industry spokesmen broadcasting this common
"clever" rogue hospice technique to avoid detection of
improprieties. Then if anything goes wrong, the hospice physician
and hospice nurses make sure that the medical record only states
the positive. How come pages suddenly come up "missing"
when outraged families request the medical records for their
loved one's case?

Why is that we regularly get complaints about hospices refusing
to even take in patients who are on expensive TPN (total
parenteral nutrition) even though the patient is certified to be
terminal and the hospice is supposed to admit these dying
patients? Why is that we get complaints about patients being
euthanized in hospices after the patient has been in hospice
"too long" and the hospice reimbursement limits have
been reached? Why is that in virtually every case where the
family complains that the hospice exploited them or did not
provide proper care... the hospice administrators deny any
wrongdoing at all, falsified medical records-accounts of what
happened during the patient's stay with the hospice and told
the outraged family members, "you're obviously having a
difficult time in grieving ... we can offer you counseling."
It is the height of gall for hospice administrators who know
something went wrong to suggest to outraged families that the
problem is with the families' grieving, rather than the
wrongdoing of the hospice!

Not all hospices do wrong. Many hospice professionals are
extremely dedicated and would never even contemplate wrongdoing.
However, the standard of practice in any industry varies. There
are hospices or staff that do not meet the standards of care. The
US Office of Inspector General has confirmed that there are
serious problems in the industry. Hospice staff confirm there are
problems.

How Rogue Hospices Escape Detection

Those hospice professionals who are offended by reports of
rogue hospices, fraud in hospice, or poor hospice services are
not aware how the "rogue" hospice operates. Many
hospice professionals are not even aware of fraud in their own
hospice. Why? Only those involved directly to see what is
happening in a specific case would know: RN case managers who
know that services are not being provided as required, social
workers who do not visit the patients and families as often as
charted, and others who write up "visit forms" for
visits that never occurred. We receive reports from inside
hospices where social workers only telephoned hospice patients
for one minute and then charted that they visited for an hour or
two!

Rogue hospices do not perform poorly all the
time, in all areas of practice. That would simply be
stupid and would result in that hospice being fairly quickly
detected. Rogue administrators are quite clever, however
unethical they may be. They pretend to be just like the ethical
hospices around them, claiming to adhere to the highest of
standards, and they vary the violations of standards of care that
they allow, so that it is more difficult to be detected; then
they claim that it was a staff error which is being corrected (if
they are found out). Giving good hospice care to some, while
exploiting others, confuses the public and allows even state
inspectors to naively believe in the integrity of the
hospice's program. Some hospices with the best reputation in
the public's eye, may have the worst reputation among other
hospices in the area, and may have the worst quality of services
actually delivered. Staff members from one hospice may care for
the "damaged" patients or families who had to endure
horrible treatment at a rogue hospice, before transferring to
another hospice, simply seeking good palliative care for their
loved one! We have received many reports from hospices about
rogue hospices who severely violate the standards of care.

Hospices Don't Want You to Know the Truth
So that Patients and Money Keep Coming In

The overall plan for state and federal health care is very
much entwined with the idea of hospice services for the
terminally ill. The government saves too much money not to
promote it. The government, the hospice organizations and all the
separate hospice agencies want to expand the public's usage
of hospice services. The government saves money compared to
sending these patients to acute care hospitals, and the hospices
make millions of dollars. These hospices are businesses and
nobody can deny that: they have a bottom line and they have to
make money to continue operations. Ethical hospices do not make
lots of money, but can break even.

Rogue hospices are making lots of money, because they take
money/reimbursement for services they don't render. They
don't want the public to know, because trust in the hospice
is necessary for families to allow their loved ones to be
enrolled in a particular hospice. Patients and families need
these end of life services, but what they really need is real
hospice care, known as "palliative care," including the
full range of services hospices are supposed to offer. Hospices
know that if the public image is maintained as
"pristine" and pure as Mary Poppins, then the patients
will keep coming in, and so will the money, but if the public is
informed, they will avoid the rogue hospices and select the
ethical hospices.

More Evidence of Serious Wrongdoing In the Hospice
Industry

Just remember that for every problem that does come to light,
there may be hundreds of other cases just like it that do not get
reported, or who are silenced by "settlement
agreements" with binding gag orders, so the families cannot
speak out about the abuse, neglect or worse by the hospice
involved. Many problematic deaths in hospice are deliberately
not prosecuted by many district attorneys around the
nation, who do not wish to rub the powerful political connections
the wrong way. District Attorneys are political creatures, in
many cases, and if they burn the wrong powerful person, their own
political aspirations may go up in smoke. So they often choose
not to prosecute hospice cases involving prominent local
physicians, nurses or hospice agencies.

"Oakland medical examiner concludes death by
poisoning"
[by hospice nurse]
By Jennifer Chambers / The Detroit News, "Waterford Township
-- After finding God, Anne Nicolai, RN wanted to make peace with
herself and the world. So, the hospice nurse wrote an e-mail to
her boyfriend in which she detailed how she killed three elderly
patients under her care, each with a fatal dose of morphine.....

PBS
Report on Investigation of Medicare Fraud in Hospices
"Correct Care?" Transcript of a report
from The News Hour with Jim Lehrer (June 19, 1997)
examining an investigation by the federal government, named
Operation Restore Trust, into instances of Medicare fraud that
have occurred in some hospices nationwide.

Review of a 1998 ?Washington
Post? report on the effect on some Hospices when being
operated by for-profit corporations which are taking over health
care. Some hospices are being adversely affected by the
"for-profit" mentality of some for profit corporations.
Although some for-profit hospices are continuing to provide
excellent care, others have failed to provide proper care.

Click here
to see the U.S. Office of Inspector General's
DRAFT COMPLIANCE PROGRAM GUIDANCE FOR HOSPICE INDUSTRY FROM
OFFICE OF INSPECTOR GENERAL (JULY 1999). Hospices are coming
under increasing scrutiny from the Federal Government. This
report details areas where unfortunately some hospices are not
complying with the regulations assuring top quality hospice care.

O.I.G. Fraud Alert about
Illegal Hospice Kickbacks
between Hospices and Nursing Homes
From the U.S. Federal Register 1998 April 24;63(79);20415-7)
This fraud alert from the U.S. Office of Inspector General
identifies types of violations of the Medicare anti-kickback
statutes seen where nursing homes and hospices might illegally
"pay" each other to influence referrals to their
respective agencies (rather than other agencies). Such referrals
may not be in the patient's best interests.

" Dial M(edicare) for Murder"
(Washington Times, 2/19/2001 by Paul Craig Roberts
available for $1.95 from archives) "...Some people are
obliged to die because they cost more to care for than they are
worth to society. Insurance companies, HMOs and government
budgeters force doctors to ration care according to the
patient's worth and prospects. ... Pay incentives and red
tape associated with treatment approvals force doctors to treat
patients with regard to cost. This means expensive procedures and
treatments are rationed and that the most efficacious treatments
are often denied until it is too late. The destruction of the
doctor-patient relationship and erosion of the Hippocratic oath
are direct consequences of do-gooders who think they can help
people by having government subsidize medical care. The
unintended consequence is euthanasia." .... "Anyone who
thinks his life is going to be respected as he grows old can wise
up by reading The Culture of Death: The Assault on Medical
Ethics in America by Wesley J. Smith."